The Keira Bell vs Tavistock case and the subsequent investigation by the Newsnight journalist, Hannah Barnes (“Time To Think”) revealed multiple significant problems with the design and operation of the children and young persons gender service at the Tavistock. These were so significant that the Westminster government ordered a review, lead by Hilary Cass, which has recommended that the Tavistock be closed and that entirely new regional services be created for the assessment and treatment of children and young people with gender dysphoria. These will be overseen by medics and closely aligned with existing Child and Adolescent Mental Health Services (CAMHS).
In Scotland, children and young people with gender dysphoria are seen at the Sandyford Clinic. There has been no legal case involving the Sandyford, and no investigative reporting, and no review of services. One might think, therefore, that ‘there’s nothing to see here’ and the Sandyford is providing a different and better kind of service from that previously provided by the Tavistock. Sadly, we doubt that.
In fact, it is hard to know just what is going on in the closed box of the Sandyford Clinic. We made a Freedom of Information request to the Sandyford in October 2022. We were interested to know whether they had experienced the same rise in referrals that the Tavistock experienced; whether they had been routinely starting their patients on puberty blockers and recommending them for cross-sex hormones and medical intervention once they reached the age of 18; and whether they had taken any more trouble to collect outcome data than the Tavistock had. But they didn’t reply to our FOI, not even to acknowledge receipt of it.
So in July we wrote to them again. This time we avoided the FOI route and we did not ask detailed questions about proportions of patients going onto puberty blockers, or how Sandyford collected outcome data. Instead, we focussed on two areas: first, the broad philosophy of the Sandyford Clinic, and second, the recommendations of the Cass report. Regarding the philosophy of the Sandyford, we asked whether it followed the same gender-ideology-inspired affirmative model that the Tavistock, at the behest of groups such as Mermaids, had followed before its closure. As to the Cass report, we were interested to know whether staff at the Sandyford had felt that any of the recommendations were relevant to their own service. We think these kinds of questions are important, so we invited a response within a month of our letter. However, once again we received no response, not even to acknowledge receipt of our letter. Dr Gerber, the clinical lead at the Sandyford, is of course under no obligation to respond. We are not his employer or his professional body. Even so, when a group of professionals raise concerns, it would in our opinion be a professional courtesy at the very least to respond to them.
So, to come back to the original question, what is going on at the Sandyford? We believe that it operates along broadly similar lines to the Tavistock, i.e. it adopts an affirmative approach, agreeing with its patients that they are the gender they say they are. We believe that its underpinning philosophy is derived from gender identity theory and gender ideology. We see no evidence that it has changed its practice in light of the findings of the Cass review (those findings, if we are right about its philosophy, must surely be relevant both to the Tavistock and to the Sandyford). We have no reason to believe that the Sandyford collects long-term outcome data, and we therefore remain concerned about the efficacy of its interventions. On the clinical grapevine, we hear that many of its staff have left, disillusioned with the service that is being provided. (We would love to talk to them, off the record if need be.)
The Scottish Government is ultimately responsible for commissioning of health services, but when I put similar questions to them, they neatly sidestepped the issue by saying that these questions should be addressed to the clinicians on the ground and, by implication, not to the politicians who oversee our public services.
All in all, then, the Sandyford Clinic is a secretive service that is difficult to hold to account. We believe that its model of care is likely to be very similar to that provided by the now-disbanded Tavistock and we have no reason to think that the issues that have arisen around the developed world (increasing numbers of referrals, changes in the demographic of the patient population) should not apply in Scotland. We are shocked by the apparent arrogance of the Sandyford leadership (refusing to acknowledge receipt of our letter of concern, refusing to answer our previous Freedom of Information request, and, as far as we can tell, failing to learn anything from the Cass report). We are concerned by the rumours that many clinical staff have chosen to leave the service. What can that mean? But our greatest concern is for the children and young people that, presumably, are still being directed towards this service.
If the Sandyford is not already in the process of taking a very long and very hard look at itself, we think that the Scottish Government should now step in. It should either commission its own version of the Cass review, led by a suitably experienced professional who is not tied to gender ideology, or insist that the lessons that are already available from the Cass review are learned not just in England but here in Scotland too. After all, don’t our children deserve evidence-based and effective healthcare, just like the kids in England?
Dr John Higgon, Clinical Neuropsychologist, Convenor of ScotPAG, August 2023